498
CARCINOMA AND TRANSITIONAL UROTHELIAL CELL
CARCINOMA OF URINARY BLADDER – a case report
S. Rajasekhar Reddy
1, Balekuduru Chaitanya*
2, P. Swarna Latha
1 1. Nizam’s Institute of Medical Sciences Hyderabad, Andhra Pradesh, India.2.Dr. NTR University of Health sciences, Vijayawada, Andhra Pradesh, India. *E-mail: bharadwaj.chaitanya@yahoo.com
Abstract:
The occurrence of both urothelial carcinoma and renal cell carcinoma is normally high in the elderly population. However simultaneous occurrence i.e synchronicity, of transitional cell carcinoma of urinary bladder and renal cell carcinoma of kidney is uncommon especially combination of papillary renal cell carcinoma & transitional cell carcinoma is very rare. We report a case of an elderly man with synchronous presentation of papillary renal cell carcinoma and transitional cell carcinoma of the urinary bladder.
Keywords:
Papillary Renal Cell Carcinoma, Transitional Cell Carcinoma, Synchronous Malignancy
INTRODUCTION:
RCC, the most lethal among urologic
malignancies accounts for 2 – 3 % of all
adult malignant neoplasms.
[1][2]In men,
urothelial carcinoma of the bladder is the
fourth most common cancer after prostate,
lung, and colorectal cancers, accounting for
6.6% of all cancer cases.
[3]Both the
malignancies tend to occur in elderly men in
the sixth to seventh decades.
[4]However
simultaneous occurrence is very rare.
CASE REPORT:
A 69 year old male presented with
complaints of 3 episodes of painless
haematuria of 3 months duration and a
swelling in the left loin of 2 months duration
associated with pain. He is a chronic smoker
with no significant past history or family
history. Per abdomen revealed a palpable
mass in the left hypochondrium and lumbar
regions. Complete urine examination
showed 6-8 RBC/ HPF.
Other renal parameters were within normal
limits. Ultrasonography showed a well
defined heterogenous mass of 8 cm in
diameter arising from lower pole of left
kidney and an irregular hyperechoeic lesion
of 2 cm along left lateral wall of bladder.
Contrast enhanced computerised
tomography (CECT) abdomen showed a
large heterogenous enhancing lesion arising
from lower pole of left kidney suggestive of
a renal tumor and a small mildly enhancing
papillary growth from left lateral wall of
bladder ( Figure 1).
Transurethral resection of bladder tumor
(TURBT) and left radical nephrectomy was
done in the same sitting. TUR accompanied
by fulgaration of the papillary growth on left
lateral wall and three small growths over
right lateral wall of urinary bladder was
performed along with left radical
nephrectomy by transperitoneal approach.
Histopathological examination revealed
papillary variant of renal cell carcinoma of
left kidney (stage T2N0M0) and a low grade
transitional cell carcinoma of the bladder
without deep muscle invasion.
Gross specimen of left nephrectomy and
histopathological images of papillary RCC
and transitional cell carcinoma of bladder
are herewith enclosed as figures 2-6. Patient
had an uneventful inpatient course and was
advised regular follow-up after discharge.
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Though many case reports simultaneous
occurrence of clear cell renal cell
carcinoma and transitional cell carcinoma
of bladder are on record, coexistent
papillary renal cell carcinoma with
transitional carcinoma of bladder are very
rare.
[5][6]The most prominent risk factor of
both renal cell carcinoma and transitional
cell carcinoma is tobacco and this patient
was found to be a chronic smoker. In
addition germline and somatic mutations
of
c-MET
proto-oncogene on human
chromosome 7q31-34 are specifically
associated with papillary renal carcinoma
and also expression of c-MET
in the
papillary urothelial carcinoma of the
urinary bladder was positively associated
with histologic grade, stage, tumor size
and growth pattern and c-MET
protooncogene has been reported to play a
more important role in the progression of
bladder cancers.
[7][8][9][10]The role of
similar risk factors and germline mutations
involving the oncogenes and tumor
suppressor genes can be of interest for
research and provide insights into the
pathogenetic mechanisms behind the
occurrence of these dual malignancies.
The management of such dual
malignancies still remains a therapeutic
challenge. Prognosis in instances of
synchronous malignancies remains poor
with the outcome being more influenced
by the aggressive primary among the two.
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